Cardiologists alarmed by COVID-19’s impact on the heart

Karen Dandurant news@seacoastonline.com @kdandurant

Thursday

May 7, 2020 at 12:54 PM

PORTSMOUTH – Cardiac doctors are concerned about an unanticipated complication from COVID-19 that is affecting people with heart conditions, and even some with no previous history of heart health problems.

COVID-19 is primarily a respiratory condition in that the virus attaches to certain receptors in the lungs. Doctors now say it may be attaching to similar receptors in the heart.

The American Heart Association has established a $2.5 million rapid research fund to fast-track scientific research to better understand COVID-19 and its interaction with cardiovascular and cerebrovascular diseases.

A quote on the American Heart Association website says that "reports are showing that people with high blood pressure or who have heart disease or survived a stroke may be more vulnerable to serious complications as a result of COVID-19. Additionally, there are reports of infected people without underlying complications who are developing deadly arrhythmias from infection and inflammation that damage heart muscle and this may further illustrate a critical relationship between COVID-19 and the cardiovascular system."

"This is an important part of the COVID-19 discussion," said Dr. Michael Mazzini, medical director of Wentworth-Douglass Hospital’s Center for Heart Health. "While we are seeing primarily respiratory infection, patients with an acute viral infection may present with a profound inflammatory response. Cardiac inflammation follows a similar pattern to pulmonary infection. People with a cardiac condition have a higher risk of infection and death."

"It’s kind of the ankle bone is connected to the thigh bone type of situation," said Dr. Peter Dourdoufis, chief of cardiology at Portsmouth Regional Hospital. "The virus is in the pulmonary system and it is not a big leap to get to the heart. The lack of sufficient oxygen (hypoxia) associated with this virus is a good source of heart attacks or arrhythmias."

Dourdoufis said the heart can also be directly affected by the virus, through an intense immune response. He said the heart attacks and arrhythmias they are seeing in COVID-19 patients are not what they would typically see, and they require different treatment.

"It is the great mimicker," said Mazzini. "There is no blockage. We have had discussions with medical centers in Boston, in New York. We have not had a case here yet, but it is definitely showing up across the country."

While patients with pre-existing conditions, like prior cardiac disease, diabetes or hypertension are more susceptible to COVID-related heart conditions, Dourdoufis said they are seeing people with no documented previous conditions.

Mazzini said some of those patients might have had hidden heart disease they were unaware of. He said that puts them at a greater risk.

"Some patients arrive with evidence of an acute heart attack," said Dourdoufis. "Our traditional course of action is to think the heart attack is the result of some type of blockage so the patient would be sent to the Cath lab for a blood clot block. The COVID-19 patients do not have a blockage."

Portsmouth Regional Hospital has the capability to do 15-minute rapid testing to determine if the patient has COVID-19, vital in terms of the way they are treated. Dourdoufis said they must decide if the heart attack or arrhythmia is the result of the usual, expected medical condition or if it is COVID-related.

"We have to think differently if the condition is caused by the virus," said Dourdoufis. "The patient does not necessarily require surgery and a stent. Instead we may be using clot busting drugs because the condition can include pneumonia, hypoxia, or clots that form in the legs or the lungs. It is the new world we are dealing with this because of this virus."

Mazzini said if a heart condition appears with COVID-19, it makes treatment of the patient that much more difficult.

"It complicates their treatment for the rest of the disease," said Mazzini. "Care is mostly palliative for the virus and now we need to care for the heart. As they move out of critical care for the virus, heart damage can still be a factor. This is still not as common as the respiratory condition yet, but it is a factor we are looking at and taking into consideration. This situation is changing every day but as cardiologists we are following developments very closely."

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